保留假体清创联合局部万古霉素治疗全膝关节置换术后早期感染

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摘要目的探讨保留假体清创联合局部关节腔注射万古霉素治疗人工全膝关节置换术后早期感染的临床疗效和可行性。方法回顾性分析2015年1月至2018年2月，我院人工全膝关节置换术后感染应用保留假体清创联合局部万古霉素治疗的24例临床资料，其中男性10例，女性14例；年龄56～79岁，平均(64.1±7.2)岁。外院感染22例，本院感染2例。病程12～28 d，平均(20.3±2.4)d。记录患者术前及末次随访的美国膝关节协会评分(knee society score，KSS)、美国特种外科医院(the hospital special surgery，HSS)膝关节评分、视觉模拟评分(visual analogue scale，VAS)、术后复发以及并发症情况，采用简易Likert量表法进行患者满意度评价。结果所有患者均获随访，随访时间8～41个月，平均(27.8±5.8)个月。手术成功率87.5%(21/24)，术后并发症发生率16.7%(4/24)。本组病例术前KSS评分(52.3±9.8)分、HSS评分(54.7±10.3)分，末次随访分别为(83.4±18.0)分、(90.6±14.5)分，末次随访评分明显高于术前(P＜0.05)。术前VAS评分为(6.3±1.8)分，末次随访降至(1.1±0.9)分，差异有统计学意义(P＜0.05)。根据简易Liket量表，患者术后满意度为83.3%(20/24)。结论保留假体清创联合局部万古霉素治疗人工全膝关节术后早期感染是安全有效的，能够显著降低疼痛、提高膝关节功能，并有着较高的成功率及患者满意度，但远期疗效仍需进一步观察。

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	周浩
	陈歌
	尹一然
	陈畅
	刘俊才
	李忠

关键词 ：保留假体清创, 人工全膝关节置换, 术后感染, 万古霉素

Abstract：Objective To investigate the clinical effect and feasibility of debridement，antibiotics irrigation and implant retention combined with local injection of vancomycin in the treatment of early infection after total knee arthroplasty.Methods From January 2015 to February 2018，the clinical data of 24 patients with early infection after total knee arthroplasty treated by debridement antibiotics irrigation and implant retention combined with local vancomycin in our hospital were retrospectively analyzed.Among them，there were 10 males and 14 females，including 22 cases of infection in other hospitals and 2 cases in our hospital.The patients aged from 56 years to 79 years (Mean，64.1±7.2 years).The course of disease ranged from 12 days to 28 days(Mean，20.3±2.4 days).The KSS sore，HSS score，VAS score at preoperative time and last follow-up，postoperative recurrence and complications were recorded and compared The simplified Likert scale method was applied to evaluate the patient satisfaction.Results The patients were followed up for 8 to 41 months (mean，27.8±5.8 months)，the cure rate was 87.5%(21/24)，and the complication rate was16.7% (4/24).The KSS score (83.4±18.0) and HSS score (90.6±14.5) were significantly higher than those before the operation (52.3±9.8) and (54.7±10.3)，the difference was statistically significant (P＜0.05).Preoperative VAS score was (6.3±1.8)，and the last follow-up decreased to (1.1±0.9).The difference was significant (P＜0.05).Using the simple Likert scale method to analyze patient satisfaction，the satisfaction was 83.3%(20/24).Conclusion Debridement antibiotics irrigation and implant retention combined with local vancomycin is safe and effective in the treatment of early infection after total knee arthroplasty.It can significantly relieve the pain，accelerate the recovery of knee joint function，and has a high cure rate and patient satisfaction.But the long-term effect still needs further observation.

Key words： debridement with implant retention total knee arthroplasty postoperative infection vancomycin

作者简介: 周浩(1993－ )，男，研究生在读，西南医科大学附属医院骨与关节外科，646000。

引用本文:

周浩，陈歌，尹一然，陈畅，刘俊才，李忠. 保留假体清创联合局部万古霉素治疗全膝关节置换术后早期感染[J]. 实用骨科杂志, 2020, 26(5): 404-411.

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